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目的探讨并评价应用rt-PA治疗6h内急性脑梗死出血性转化的临床意义及相关影响因素。方法将满足入选标准的209例患者随机分成3组,其中甲组给予0.9 mg/kg的rt-PA;乙组给予0.7 mg/kg的rt-PA;丙组为对照组,同时将3组又分成克赛亚组(甲1、乙1、丙1)与非克赛亚组(甲2、乙2、丙2)。通过CSS与BI对溶栓前、溶栓后24 h、3 d、7 d、90 d的疗效进行评价。结果甲组与乙组的总出血发生率、48 h脑出血率以及14d脑出血总出血率均高于丙组,差异显著(P<0.05)。甲组、乙组与丙组在症状性脑出血率方面比较无显著差异(P>0.05)。甲组与乙组的90 d显效率以及90 d痊愈率均高于丙组,差异显著(P<0.05)。甲组与乙组的90 d病死率均低于丙组,差异显著(P<0.05)。甲组与乙组的上述各分析结果之间无显著差异(P>0.05),克赛亚组和非克赛亚组之间比较,无显著差异(P>0.05)。结论应用rt-PA进行静脉溶栓6h内将增加急性脑梗死出血几率,但可以增强治疗效果并减低病死率,提示应用rt-PA在6h内静脉溶栓在治疗急性脑梗死方面的是可行的,应用剂量以0.7mg/kg为宜。
Objective To investigate and evaluate the clinical significance and related factors of hemorrhagic transformation of acute cerebral infarction within 6 hours after rt-PA treatment. Methods A total of 209 patients meeting the inclusion criteria were randomly divided into 3 groups: group A received rt-PA at 0.9 mg / kg; group B received rt-PA at 0.7 mg / kg; group C served as control group and group 3 Divided into the Kexiya group (A 1, B 1, C 1) and non-Kexiya group (A 2, B 2, C 2). The efficacy of CSS and BI before thrombolysis, 24 h, 3 d, 7 d and 90 d after thrombolysis was evaluated. Results The total hemorrhage rate in group A and group B, the rate of cerebral hemorrhage 48 h and the rate of total hemorrhage 14 d were higher than those in group C (P <0.05). Group A, Group B and Group C in the rate of symptomatic intracerebral hemorrhage no significant difference (P> 0.05). The effective rate of 90 days and the recovery rate of 90 days in group A and group B were higher than those in group C (P <0.05). The 90-day mortality rates of Group A and Group B were lower than Group C, with significant difference (P <0.05). There was no significant difference (P> 0.05) between the above analysis results of group A and group B. There was no significant difference between the groups of testis and non-group (P> 0.05). Conclusion Intravenous thrombolysis with rt-PA within 6 hours will increase the risk of acute cerebral infarction bleeding, but can enhance the therapeutic effect and reduce the mortality, suggesting that rt-PA within 6h intravenous thrombolysis in the treatment of acute cerebral infarction is feasible , The application dose to 0.7mg / kg is appropriate.